Reducing methotrexate

[Bluesew]

I am due to see my rheumatologist next week and thought I would see what the wonderful, knowledgeable people on this forum think first.

My last appointment was in March when I was on 3mg pred and 10mg mtx. The hope was that I may have tapered to zero by September, dropping by 0.5mg every 4-6 weeks and continuing to take the mtx. I should have asked why I needed to continue with the mtx but I was not quite with it as I was just recovering from a parathyroid op ( unfortunately unsuccessful). Not quite at zero, but at 0.5mg.

My question is does anyone have experience of stopping mtx - does it need to be tapered over several weeks/ months? I will have to miss several doses anyway this autumn when I have the flu and covid jabs.

[PMRpro Ambassador]

It seems to depend on the rheumy - some leave you taking it indefinitely as it is used in RA. others taper it once the patient is at zero pred if they get there - some don't. Some people have decided to stop MTX because they didn't think it was doing anything - only to discover it really was doing something and without it they flared!

[Bluesew in reply to PMRpro]

Thanks. I’ll have to see what the Rheumy says. Don’t really want to continue taking it, but as you say it might be doing more than I know.

[dancersize2]

PMR since 2017. MTX added 2019. Got pred to zero end of 2021. By then I'd reduced the MTX to 15mg weekly with a gentle taper just in case. Rheumy said stay on MTX so I tapered again to 10 and was happy there until April 2023. Pain returned, GP decided I now have rheumatoid arthritis so need to increase the MTX back to 20. That did work by June 2023 and I've continued with that dose but am considering dropping back to 15 as it makes me nauseous for a couple of days after I take it. Only have phone appt with rheumy each six months so I make my own choices and then deal with any consequences. So far I think oesteo causes more problems than the RA for me.

[PMRpro Ambassador in reply to dancersize2]

My rheumy suggests taking MTX as a split dose - half before bed and half next morning and says he finds that reduces the risk of nausea. It was the one expected adverse effect I didn't have! And more folic acid is also supposed to help.

[dancersize2 in reply to PMRpro]

Have folic acid six days, I'll try spitting the dose. Thank you.

[PMRpro Ambassador in reply to dancersize2]

5mg per day I assume? I was so relieved I didn't feel nauseous - I found MTX bad enough and stopped anyway but nausea is awful isn't it?

[5lupins]

I have been on methotrexate since 2010, slowly reducing to 7:5 mg in 2022. Saw rheumi in May and after a pet scan and MRA it showed aorta was inflamed so back to 10mg weekly. I also take 2;5 mg of prednisolone for life. I take 5mg of folic acid 24hrs before methotrexate. I am ok but have never felt really well. Everyone is very different it seems. I would go slowly and the you will recognise how you are. J